0010-177 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cv W Professionals Code, and my License is in full force and effect.
�Cn License # Lic. Class Exp. Date
LU
6V �� 0-151 103
cZ ti 0ale f" f- ✓" i' �'' Signature of Contractor'
O h r
J U 0 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ 11 License Law for the following reason:.
Z_ ( ) I, as owner of the. property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the. property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C") O I am exempt under Section , B&P.C. for this reason
I
O N Date Signature of Owner
rn
a- Q WORKER'S COMPENSATION DECLARATION
p Im I hereby affirm under penalty of perjury one of the following declarations:
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
M Q U `� �)' I have and will maintain workers' compensation insurance, as required by
QSkion 3700 of the Labor Code, for the performance of the work for which this
U
Il' rn H permit. is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
g (This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance. of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject.to the
workers' compensation laws of California, and agree that if I should become
/UD'tto the workers' compensation provisions of Section 3700 of the Labor
3 Ishall/forth ith comply with those proyyisiops. Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall,,indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the bove-mentioned property for inspection purposes. f
ignature (Owner/Agen7 J" / Date i% �! <
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0010.177 TRACT
62,.4(3
10/ 1rii`loc S4362,.40
JOB SITE
APN
ADDRESS
45.-M I)FDRE
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
a, 11C1U&11'U1)TX*9
ATLAS AVA41.1'Cs COMPANY
,I5.3 Rt►:(_'a;[;1rZ}3I ?wS1z
7M Vn1,I,1VM RC:F TD
LA, Q111NTA CA 92255 ;
PALM i;PR 14GS CA 92264
(76q)327-8466 MR. 11325
USE OF PERMIT
.144 L.F.., ALU.MQAW000 PATIO C rA ER. PER.AI`3PRkWiX.1D PLANS X113:
0762.1 P ONLY
PORCH/PATIO 328.00 SF
:FsFUMA c(Wf OF Ci)MMIMMd:. N
4X�_140
FE.RuTrykE Numbla Y
i:C)N117fRUCTION r."'LP 1 I!oI-Wo'i18-000 $71,00
S^f.R.tD*4N4tS`1'1014 FK • RKSID 101.000441-000 00
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OCT 18 200
\` XYY yr LA
NT.
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$119,.V
RECEIPT
DATE:•.
BY . -"''"-
DATE FINALED
INSPECTOR
.
MPECTM RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BNJpILMNG APPROVALS MECH[9 MCAD, APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
— _ Final
Final ''Z Fel C'�
G`- 0CKWP1%LL AFF r"uOVALS steel --
Set Backs Electric Bond
Footings — — — _ --- Main Drain
_
Bond Beam —� i Approval to Cover
—_—_
I Equipment Location
Underground Electric
Underground Pibg. Test
_
(Final Gas Piping
_
Gas Test
Electric Final
Wasfe Lines �` Heater Final
Water Piping _
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
_
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final .
COMMENTS;
(Final
Utility Notice (Gas)
ELEC f MCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Povver
�OPD70 _
Utility Notice (Perm)